Vitiligo

By: Tina Shahian, PhD

Last Updated: Mar 1, 2019

Overview

Vitiligo is a disorder characterized by blotches of discolored skin. The blotches appear lighter in color because the underlying cells that give skin its color (melanocytes) either die or lose function. Vitiligo is commonly observed on exposed skin (e.g. face, neck, hands) but can affect any part of the body that has pigmented cells. In some cases, it may cause loss of color inside the mouth, on the eyes, and on the hair. Due to this alteration of physical appearance, it can lead to severe social and emotion anxiety. Other complications include vision or hearing difficulties and sensitivity to the sun.

There are two types of vitiligo: segmental and non-segmental.

• Segmental vitiligo affects one segment, or side, of the body (a hand, a leg, or the face) and in 50% of individuals some hair (on head, eyebrows, eyelashes). Symptoms appear at an early age and progress for only a few years.
• Non-segmental vitiligo is more common and affects both sides of the body. It usually begins with a short-lived burst of discoloration on the hands, feet, or face. The affected areas expand with new cycles of pigment loss that occur throughout the person’s life.

The extent of pigment loss on the body is described as localized, generalized, or universal. The localized and universal subtypes describe the two extreme forms of disease - a few blotches versus pigment loss over the majority of the body, respectively. The most common subtype of vitiligo is generalized, which is characterized by scattered patches throughout the body.

In America, 1 to 2 million individuals suffer from vitiligo. This disease is not contagious or life threatening, and has been observed equally across all genders, races and ethnicities. Vitiligo is a lifelong condition that generally begins before the age of 20. There is no cure, but there are ways to minimize the appearance of skin discoloration. Popular musical figure Michael Jackson was famously known for suffering from this skin disease.

Causes and Risk Factors

The light/white blotches of skin associated with vitiligo form when melanocytes fail to produce melanin. It is not known what causes melanocytes to die or stop producing melanin, but the following may play a role:

• Autoimmune disease. Autoimmune diseases occur when the body mistakenly attacks and destroys its own cells. Hyperthyroidism is one such condition that may launch an immune response against melanocytes.
• Family history. Individuals with a family history of vitiligo are more likely to inherit the genetic factors that affect melanocyte function.
• Distress. Excessive stress or exposure to sun and certain hazardous chemicals may also trigger pigment loss.

Symptoms

The main symptom of vitiligo is pigment loss on the skin. The light/white blotches generally appear before the age of 20 and can vary in size and number. This condition is not associated with physical pain or discomfort. Symptoms may appear as:

• Discolored skin on the face, arms, hands, or feet (most common)
• Discolored skin on other parts of the body (armpits, genitals, rectum, etc.)
• Light colored tissue along the inside of mouth and nose
• Loss of color in the hair (head, eyebrows, eyelashes, and facial hair).

Diagnosis and Treatment

In order to diagnose vitiligo, a physician will examine the affected skin and inquire about possible family history of the disorder. Blood tests that check for autoimmune thyroid disease or biopsies of the affected tissue may be performed. Individuals with discoloration in the eye or ear may require examination by a specialist for those organs.

Since no cure is available for vitiligo, the main goal of treatment is to improve the appearance of discolored skin. The safest treatment option is cosmetics. Medication, light therapy, and surgery can cause dryness, itching, and burning of the skin or more serious side effects.

• Cosmetics. Applying makeup or skin tanners to the affected areas can mask minor cases of vitiligo. Although cosmetics require frequent application, they are generally safe and free of side effects.
• Medication. Topical creams that affect the immune system or control inflammation (corticosteroid) may help re-pigment the skin. These creams may be used in combination with ultraviolet light to improve results. Due to adverse reactions, these treatments are generally used for small areas on the face and neck. Those with widespread vitiligo may wish to remove pigment from the remaining unaffected areas by applying topical creams that gradually lighten the skin.
• Light therapy. Repeated courses of light therapy can help restore some color to the affected skin on the face, trunk, and limbs by triggering the skin’s natural healing process. In photochemotherapy, ultraviolet A (UVA) or ultraviolet B (UVB) light is used in combination with a drug that makes the skin more sensitive to UV light. Alternatively, narrow band UVB light can be used alone.
• Surgery. Surgical options are available when cosmetics, medication, or light therapy do not yield desirable outcomes. Skin and blister grafting techniques involve removing pigmented skin from unaffected areas and attaching it to small areas of discolored skin. These procedures may cause scarring and change the texture of the treated areas. Pigment can also be delivered to the discolored skin via tattooing. All surgical options pose the risk of triggering pigment loss in neighboring skin.

Prevention

Most cases of vitiligo cannot be prevented. Reducing exposure to known triggers (e.g. sun, chemicals, stress) can help prevent pigment loss in new areas of the body.

Sources

• “Vitiligo”. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Retrieved Mar 19, 2015. http://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html.
• “Vitiligo”. Mayo Clinic Foundation. Retrieved Mar 19, 2015. http://www.mayoclinic.org/diseases-conditions/vitiligo/basics/definition/con-20032007.
• “Vitiligo”. American Academy of Dermatology (AAD). Retrieved Mar 19, 2015. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/u—w/vitiligo.